4 ms·

I have to ask, are you suffering from a Type 1 diabetes? If not, at least for me, this answer kind of misses the point completely. Type 1 is a hell to manage. I

by pimeys 5y ago

I have to ask, are you suffering from a Type 1 diabetes? If not, at least for me, this answer kind of misses the point completely. Type 1 is a hell to manage. It is REALLY hard. Like I actually use an open source pancreas to control my glucose levels so now I can sleep every night without having to worry about dying. This is in Europe where the insurance covers everything and prices are cheaper than in US. Using the Walmart insulin makes everything much much more complex, and even for the smartest of us, even with the best possible insulins, managing T1 is a HUGE pain and can kill you quite fast. I hope I misread your comment...

RHSeeger 5y ago
I do have type 1 diabetes, and I lived on R/L for over a decade. The point being made here is > The high price of tier 1 insulins is killing people Is (more or less) a lie. While > The high price of tier 1 insulins is making people's lives considerably worse and their diabetes harder to manage. Is (more or less) true. When you try to push for change and use, as part of your argument, a lie, you sabotage yourself. People can point at what you're saying and, ignoring the validity of what you're trying to achieve, say "you're lying". That's bad. The truth is that there are good reasons why tier 1 insulins should not cost as much as they do, not by a long shot. And destroying your own progress towards changing things is counter productive. Just don't do it.
- burkaman 5y ago
  It is not a lie if you think about real human behavior, rather than a theoretical rational automaton. There are real, documented cases of people who were prescribed insulin they could not afford, tried to ration it, and died as a direct result. Maybe their doctor told them not to use it, or they didn't live near a Walmart, or they didn't know it existed. Maybe they tried the Walmart stuff and almost died because it's so difficult to manage, so their doctor told them to switch back to the best treatment available. I promise they did not die to make a political point. One in four patients in the US have rationed insulin because of the cost: https://news.yale.edu/2018/12/03/one-four-patients-say-theyve-skimped-insulin-because-high-cost https://news.yale.edu/2018/12/03/one-four-patients-say-theyv... It is simply untrue to say the high cost only forces people to use the cheaper Walmart generic. That isn't what happens. They ration it, and sometimes they die. Finally, it doesn't make sense to say that the high price is making diabetes harder to manage, but isn't killing people. That's like saying speeding doesn't kill, it just makes the car harder to manage.
  - RHSeeger 5y ago
    Correction > One in four patients say they’ve skimped on insulin because of high cost > say they've ^ is the key component. I expect the vast majority of those people had a choice, and they chose not to take it. A poor choice, and a choice they shouldn't have to make, but a choice nonetheless. The point is, if you're going to fight for positive change, use an argument that can't be trivially dismissed because it isn't true. Fight effectively.
    - burkaman 5y ago
      Yes, why did they choose not to take it? Try to empathize with these people. Why did they do something so dangerous? Then follow it one step further. In the case of those that died, why did they die? What factors contributed to their death? If the price of insulin had been lower, and everything else was the same, would they have died? I would argue these two statements are equivalent: - My patient was killed by the high price of insulin. - If the price of insulin had been lower, my patient would still be alive. I suspect that you accept the second statement, but not the first. What's the difference?
      - RHSeeger 5y ago
        They are two different, but related, things. There are people who die early because they eat extremely poorly; lots of fats and sugars. 1. If the fatty and sugary foods were too expensive for them to buy, they would not have died from those things. 2. They did not die because fatty/sugary foods weren't expensive. They died because they chose to eat fatty/sugary foods. [1] Just because X (good insulin being cheaper) would have helped prevent Y (deaths) doesn't mean that <not X> caused Y. [1] I'm ignoring the fact that truly healthy foods tend to outside the price range of the poorer segment. The analogy only really goes so far here.
        burkaman 5y ago
        Ok, I guess that's the core of our disagreement. I do believe that "X prevents Y" means "<not X> causes Y". Thanks for the discussion.
- oasisbob 5y ago
  Saying that cheap insulin kills people seems like a hyperbolic, but essentially true statement. It's well known that you need to keep all sorts of things under control with type 1 to avoid long-term health complications. Blood sugar is the most obvious. I watched my father manage his for decades, starting in the 1980s. The technology improvements were interesting - his first insulin pump (about the size of a VHS tape), the custom software to data-dump his glucose meter, "supply-hacking" to keep the infusion sets affordable... He still had management challenges despite being a dedicated, disciplined, marathon-running Mormon on the leading-edge of treatment. He was fortunate enough to be involved in the DCCT/EDIC trials at the University of Washington, and took the early lessons about future complications very seriously. You make Diabetes harder to manage by removing modern improvements to the standard of care, and you are certainly going to see increases in deaths and severe negative outcomes.

by pimeys 5y ago

RHSeeger 5y ago

I do have type 1 diabetes, and I lived on R/L for over a decade. The point being made here is > The high price of tier 1 insulins is killing people Is (more or less) a lie. While > The high price of tier 1 insulins is making people's lives considerably worse and their diabetes harder to manage. Is (more or less) true. When you try to push for change and use, as part of your argument, a lie, you sabotage yourself. People can point at what you're saying and, ignoring the validity of what you're trying to achieve, say "you're lying". That's bad. The truth is that there are good reasons why tier 1 insulins should not cost as much as they do, not by a long shot. And destroying your own progress towards changing things is counter productive. Just don't do it.

burkaman 5y ago
It is not a lie if you think about real human behavior, rather than a theoretical rational automaton. There are real, documented cases of people who were prescribed insulin they could not afford, tried to ration it, and died as a direct result. Maybe their doctor told them not to use it, or they didn't live near a Walmart, or they didn't know it existed. Maybe they tried the Walmart stuff and almost died because it's so difficult to manage, so their doctor told them to switch back to the best treatment available. I promise they did not die to make a political point. One in four patients in the US have rationed insulin because of the cost: https://news.yale.edu/2018/12/03/one-four-patients-say-theyve-skimped-insulin-because-high-cost https://news.yale.edu/2018/12/03/one-four-patients-say-theyv... It is simply untrue to say the high cost only forces people to use the cheaper Walmart generic. That isn't what happens. They ration it, and sometimes they die. Finally, it doesn't make sense to say that the high price is making diabetes harder to manage, but isn't killing people. That's like saying speeding doesn't kill, it just makes the car harder to manage.
- RHSeeger 5y ago
  Correction > One in four patients say they’ve skimped on insulin because of high cost > say they've ^ is the key component. I expect the vast majority of those people had a choice, and they chose not to take it. A poor choice, and a choice they shouldn't have to make, but a choice nonetheless. The point is, if you're going to fight for positive change, use an argument that can't be trivially dismissed because it isn't true. Fight effectively.
  - burkaman 5y ago
    Yes, why did they choose not to take it? Try to empathize with these people. Why did they do something so dangerous? Then follow it one step further. In the case of those that died, why did they die? What factors contributed to their death? If the price of insulin had been lower, and everything else was the same, would they have died? I would argue these two statements are equivalent: - My patient was killed by the high price of insulin. - If the price of insulin had been lower, my patient would still be alive. I suspect that you accept the second statement, but not the first. What's the difference?
    - RHSeeger 5y ago
      They are two different, but related, things. There are people who die early because they eat extremely poorly; lots of fats and sugars. 1. If the fatty and sugary foods were too expensive for them to buy, they would not have died from those things. 2. They did not die because fatty/sugary foods weren't expensive. They died because they chose to eat fatty/sugary foods. [1] Just because X (good insulin being cheaper) would have helped prevent Y (deaths) doesn't mean that <not X> caused Y. [1] I'm ignoring the fact that truly healthy foods tend to outside the price range of the poorer segment. The analogy only really goes so far here.
      - burkaman 5y ago
        Ok, I guess that's the core of our disagreement. I do believe that "X prevents Y" means "<not X> causes Y". Thanks for the discussion.
oasisbob 5y ago
Saying that cheap insulin kills people seems like a hyperbolic, but essentially true statement. It's well known that you need to keep all sorts of things under control with type 1 to avoid long-term health complications. Blood sugar is the most obvious. I watched my father manage his for decades, starting in the 1980s. The technology improvements were interesting - his first insulin pump (about the size of a VHS tape), the custom software to data-dump his glucose meter, "supply-hacking" to keep the infusion sets affordable... He still had management challenges despite being a dedicated, disciplined, marathon-running Mormon on the leading-edge of treatment. He was fortunate enough to be involved in the DCCT/EDIC trials at the University of Washington, and took the early lessons about future complications very seriously. You make Diabetes harder to manage by removing modern improvements to the standard of care, and you are certainly going to see increases in deaths and severe negative outcomes.